an unobligated balance of $188,863 at the end of the year, the larger part of which accrued, due to the fact that in the previous estimate allowance was made for personnel for the new female receiving building, which the contractor did not complete and turn over to the hospital until June 1936, very nearly 1 year late; secondly, the hospital, on account of shortage of beds, found it necessary to discharge every patient that could get along at home, even if on trial, reducing the estimated population included in the Interior Department Appropriation Act from 1,800 patients to 1,722 patients, or 78 patients, at $657 each, amounting to $51,246, these two items accounting for the difference noted in estimated savings and unobligated balance. During 1936 the cost of supplies were approximately on the same average as the previous year. The reimbursements, in addition to the appropriations, are estimated for the 3 years, as follows

The number and classes of patients covering the foregoing are as follows:

There is an increase of 140 from the District of Columbia, 3,400 having been estimated for 1937. There were 3,314 of such patients, the average, during 1936. It is believed that this is a conservative number, as the admissions seem to be on the increase. The number of Veterans' Administration beneficiaries, 104, is 2 more than were actually in the hospital in 1936 and 8 less than estimated for in 1937. The number in the hospital at the present time is 102. This number varies but little; there may be one or two increase or a deduction of one or two. The number estimated for the Public Health Service beneficiaries is 132; 130 were estimated for during 1937, and there were 130 in the hospital during 1936. There are 131 in the hospital at the present time. This seems to be a conservative number. The estimated number for the United States Soldiers' Home is 40; 35 were estimated for in 1937, and there were 37 average number in the hospital during 1936. These beneficiaries seem to be slightly on the increase, and 40 is considered a conservative number. The estimate of 70 beneficiaries of the Indian Bureau is the same as for the previous year, compared with an average of 68 in the hospital during the year 1936. At the present time there are 70 of these beneficiaries in the hospital.

Included in the estimate is $185,000 for repairs and improvements to buildings and grounds. This is the same amount as was carried in the appropriations for the several preceding years. The buildings have been erected from time to time during the many years since the first authorization for construction of the hospital in 1852. In order to keep them in operation, it is found necessary to recondition the various old buildings, replace many of a more or less fire-menace construction with fireproof materials, renovate the plumbing, replace electrical wires and fixtures, and refloor, replaster, and repaint the various rooms and halls in these buildings. The cost of constructing the present buildings is $8,500,000; if the repairs were only 21⁄2 percent, it would require $212,500 annually to keep these buildings in proper condition. In addition to repairs to the buildings,

part of the appropriation limited for this purpose must be used for repairing roads and walks, replacing old roads and walks, and widening roads to meet new conditions brought on by the use of automobiles and extraordinary hard usage given to roads by heavy trucks.

There is an item in the appropriations showing a limitation of $27,000 for the purchase, exchange, maintenance, repair, and operation of motor-propelled passenger-carrying vehicles. Of this amount, $1,225 net is to be used for replacing two old machines and $25,775 for maintenance, repair, and operation of all cars. This includes salaries for chauffeurs; the cost of gas, oil, and grease; the amount expended for repair items; and the cost of mechanics and helpers.

The provision permitting the operation of a cafeteria for the use of employees and others, the cost of food furnished to be at not less than cost and the proceeds therefrom to reimburse the appropriation for the institution, is again included in this estimate. This item permits the furnishing of food to employees on the hospital grounds, there not being facilities within the neighborhood where the employees could secure their meals within the time allotted for this purpose. It also permits visitors to the hospital to purchase their meals and, when the condition of the patient permits, to have their meals with the patient, who may be a relative or friend. Detailed reports are annually filed with the General Accounting Office covering the transactions of the cafeteria.

There is a provision that permits not exceeding $1,500 of the amount appropri ated to be expended in the removal of patients to their friends. This amount permits patients, who are ready to be discharged and who have no funds, to be returned to their homes at the expense of the hospital.

There is a provision that authorizes not exceeding $1,500 to be used for the purchase of such books, periodicals, and newspapers as may be required for the purpose of the hospital and for the medical library. The hospital has a circulating library which is used by the patients. About 200 books a day are withdrawn from this library, and many hundreds of periodicals and magazines are read by the patients daily. Newspapers from several cities are secured and furnished to the patients out of this amount. Out of this amount are also purchased directories, dictionaries, and review books. There has been no change in this amount for several years.

A provision permitting not exceeding $1,500 to be used for payment of the necessary expenses in the apprehension and return to the hospital of escaped patients is included. This provision permits the hospital to reimburse anyone who assists in returning a patient who may wander from the hospital grounds and the cost of any expense that may have been incurred by such act.

There is a provision that permits as much of the sum as may be required to be available for all necessary expenses in ascertaining the residence of inmates who are not, or who cease to be, chargeable to the Federal maintenance of the institution and returning them to such place of residence. This permits the hospital to pay the expenses of former criminal patients whose time expires, and who require further treatment, of transportation to their native State.

The amount required for pay of personnel is $2,543,675. This is an increase of 53 in personnel in order to take care of the increase in patient population and the additional buildings which are being opened. The additional number of employees will require $65,000 per annum. Included in this are the following: 1 associate medical officer; 1 assistant medical officer; 36 hospital attendants; 2 junior clerk typists; 1 senior guard; 6 junior laborers; and 6 minor domestic attendants. Total, 53 additional employees, $68,320; decrease in temporary personnel, $3,320; net increase in personnel, $65,000.

The estimate for supplies of the various classes shows but little increase, the cost of provisions having increased $20,000; the item of fuel, $10,000, while there is a decrease in the cost of wearing apparel and forage. A net increase of approximately $15,000 for all supplies.

During the past year the money allocated by the Public Works Administration for the extension of waterworks and reconditioning porches has been expended. With the money authorized for reconditioning porches, many wooden porches which were more or less of fire menace have been torn down and in their place brick and concrete porches erected, which not only give better safety from a fire standpoint but are larger, more confortable, more sanitary, and in every way a desirable addition to the hospital.

The money allocated for extension of waterworks permitted the hospital to sink a 30-inch gravel well, with a flow of water of approximately 1,900,000 gallons a day, sufficient for all of its needs without calling upon the District of Columbia for any part of its supply. Out of the money allocated for this purpose, all the

fire lines have been replaced, new fire hydrants installed, new fire pumps purchased and set up ready for use, and a new tank erected with a capacity of 100,000 gallons. This tank has been set higher than the old tank permitting an adequate water pressure to the higher floors of all the new buildings. This will do away with the necessity of running pumps continuously in several of the newer buildings in order to furnish sufficient pressure to the upper floors.

The money allotted by the Emergency Relief Administration, amounting to $9,500, permitted the construction of storm sewers surrounding the power-house, relieving the condition which existed in this vicinity resulting in the flooding of the floor of the power-house and insanitary conditions in this vicinity.

The female receiving building, which was under construction at the time of the last report, was not completed at the time expected. The contractor met with several delays which retarded the opening for approximately 9 months. As explained in the earlier part of this justification, money appropriated for the hiring of personnel to be used in the opening of this building could not be used and reverted to the Treasury, under the title of estimated savings and unobligated balance. This amounted to something in excess of $100,000. The building was opened about the first of July 1936 and tended to somewhat relieve the overcrowded conditions. New admissions during the year again put beds at a premium and made it necessary to consider the erection of additional buildings to provide more beds.

Mr. SANGER. There is just one statement that I would like to make. There is a correction that should be made on page 3 of the justification. Where we say that about 1,200 books a day are withdrawn from the library, that should be changed to 200 books are withdrawn each day and that there are 3,600 books in circulation. That is just a typographical error.

Mr. LAMBERTSON. The passing of Dr. White was no doubt a great loss to the hospital.

How much is your population now?

Mr. SANGER. I can give you that information. The total number of patients in the hospital today is 5,596. The average number since July 1 is 5,504.

TRANSFER OF VETERAN PATIENTS

Mr. LAMBERTSON. On page 2 of your justification there is a classification which indicates where the patients come from. What is the reason for the decrease in veterans?

Mr. SANGER. The Veterans' Administration are gradually transferring the veterans to their own institutions.

As you

Dr. HALL. We used to have approximately 900 veterans. probably know, it has been the policy of the Veterans' Administration to transfer its beneficiaries to hospitals in their own sections of the country. The only Veterans' Administration patients that we have are the ones from this immediate vicinity and the ones whose relatives or committees objected to transfer.

Mr. RICH. In regard to your talking about returning these exservice men to their own hospitals that have been in your hospital, do you think that you can take care of them better and cheaper because of the facilities that you have over there, or do you advise returning them to the Veterans' Administration to take care of them? Dr. HALL. We are not generally consulted about that, because they are Veterans' Administration wards; and the Veterans' Administration of course, can hospitalize them wherever it chooses.

Mr. RICH. That was not the question. Do you figure that you are able to take care of them better than any of the other institutions? Dr. HALL. I would not say so. I think we have a pretty good hospital, but the Veterans' Administration hospitals are good too.

Mr. RICH. You cannot put those patients into a general hospital, can you?

Dr. HALL. Oh, no. They are transferred to Veterans' Adminis tration hospitals.

Mr. RICH. I know that, but I am speaking of the syphilis cases. Do they have a hospital that deals exclusively with diseases of this kind?

Dr. HALL. No.

Mr. RICH. You have them segregated in your hospital, do you not? Dr. HALL. No.

Mr. RICH. You do not?

Dr. HALL. No. These cases are noninfectious. I mean, this is a late stage of the disease, when there is never any question of infection to others. It is only in the earlier stages of the disease that it is infectious.

INDIAN PATIENTS

Mr. LAMBERTSON. These are not all of the Indians that the Govern ment is supporting in institutions of this kind, are they? There are in other places that you know of?

Mr. SANGER. There are the Alaskan Indians, who are cared for in a private institution in Oregon. But these are all of the regularly accepted Indians that are wards of the United States and are in mental institutions.

ADEQUACY OF ESTIMATES

Mr. LAMBERTSON. I see that your estimate this year is a little les than it was last year.

Mr. SANGER. That is due to the following: On account of the overcrowded conditions, great efforts were made to discharge all patients that could be trusted to be cared for in their own homes or where there was a good possibility of early recovery. Every effort was made during the year to get out the patients. The estimate was based on 1,750 instead of the previous year's 1,805.

The 1,750 is going to be too low, however, because at the present time we have 1,785 chargeable to the appropriation for the hospital, and we have had an average since July 1 of $1,741. But that is how the estimate was made.

REPAIRS AND IMPROVEMENTS TO BUILDINGS AND GROUNDS

Mr. LAMBERTSON. In the item of repairs and improvements, what do you have to say about this estimate of $185,000?

Mr. SANGER. That is based upon a careful estimate of the condition of the buildings and the necessity for keeping them in repair.

Many of the buildings have been built at various times from 1855 up to the present time. These buildings when originally built had no modern improvements. Electricity was unknown at that time, naturally. The water conditions were entirely different. Fireproofing was lacking.

We have been gradually and continuously remodeling and renovat ing in order to continue the use of a good outside structure and try to bring it as near as possible up to the modern-day practice in order to avoid new construction.

In addition, in 1918, during the war period, we had an unusually large number of patients come to the hospital. We secured an appropriation of $200,000 to build some semipermanent buildings, about nine, seven of them containing beds, one a dining room, and one a kitchen, which we estimated would have a life of 50 years.

Much of the lumber that was used in those buildings was green, and it has warped; and those buildings have almost outlived their useful

ness.

Mr. LAMBERTSON. They are on the east side, are they not?

Mr. SANGER. Yes. They should be replaced. The cost of repairing those buildings we have figured to be 5 percent of the original cost each year.

I have here a statement of what enters into that repair item, which I will present. This shows how the item of $185,000 in the 1938 appropriation is divided up.

We have estimated for 1938 that for general repairs to the S. P. B. group of buildings we can go ahead with $10,000. That is the one that I just spoke of.

New floors in the Howard Hall group, which is the colored and criminal section, and the original central group of buildings, $12,000.

Replacing glass and putting in additional glass will cost us $8,000

a year.

Replacing wooden doors to basements with fireproof doors opening on stairways, $4,500.

Fireproofing elevator shafts and replacing elevator doors $5,500. Repairing and renewing roofs, $6,000.

Renewing wooden stairways in the hall of the center building, from the first to the fourth floors, and installing enclosed fireproof stairway, $18,000.

That is the original building. It has narrow stairways about 5 feet wide. In this building is the present chapel, where all the patients go. The fire department and the Federal Fire Council both have strongly recommended the replacement of these stairways.

New roads and replacing and repairing old walks and roads, $20,000. Mr. RICH. Is that what you spent last year?

Mr. SANGER. We spent $16,000 last year, but we had some money the year before from Public Works funds.

Mr. RICH. Then you spent for doing the work around the property only $20,000?

Mr. SANGER. $20,000.

We have 11 miles of walks and roads in the grounds. Many of the roads were constructed before we had automobiles, and they are so narrow that if an automobile is parked on one side, a machine has difficulty in passing.

Mr. RICH. Do they have a substantial road base good enough to handle traffic outside of the fact that they are narrow?

Mr. SANGER. Not heavy traffic. We have had several occasions where heavy trucks have broken through when bringing supplies to the hospital. Evidently they didn't foresee the heavy class of traffic that we are having on those roads today.

Steamfitting and plumbing repairs, remodeling heating, additional radiators and piping, $63,000.

Painting and plastering old buildings, $17,000.

Repairs to shop buildings, laundry, and storerooms, $8,000.